November 30, 2006

NST: MY sister has just completed her degree in medicine overseas and should be returning to serve as a house officer in any hospital in Malaysia.
To my surprise, her seniors in university, who are currently serving house officers and medical officers in Malaysia, are discouraging her and her classmates from returning to practise in Malaysia.
Their main reasons are that house officers are often shouted at and humiliated in front of others, including patients and fellow colleagues.
There are also the long working hours.

On days that a house officer or medical officer is “on call”, he/she is subjected to the following working hours:
• Monday: 7.30am to 5pm (normal working hours);
• (On call) 5pm to 7.30am the following day;
• Tuesday: 7.30am to 5pm (normal working hours).
This means that a house officer/medical officer who goes to work on Monday starts his/her work at 7.30am and it only ends at 5pm the following day.

This means that he has to work 34 hours before he or she can go home.
The fact that such working hours have long been practised is not a justification and not a valid excuse.
The Health Ministry needs to make changes to improve the working environment of doctors in hospitals in Malaysia.
The current practice and working environment are clearly discouraging doctors from returning to Malaysia to work. In the long term, this will cause a brain drain in the medical profession.

NST: KUALA LUMPUR: The year- long housemanship can be a steep learning curve. Exhaustion and long hours are par for the course.
But new doctors should look on it as a time to gain valuable experience.
Malaysian Medical Association president Datuk Dr Teoh Siang Chin said: “The first year of a doctor’s life can be very difficult, but it is their vocation and they should think positively.
“They are lucky to get such hands-on experience.”
Dr Teoh was asked to comment on a Letter to the Editor published in the New Straits Times yesterday, which said that medical students studying overseas were being discouraged by their seniors to return to practise in Malaysia.
Long hours, and being shouted at and humiliated in front of others were two of the reasons given.
The letter said that housemen have to work their normal shift from 7.30am to 5pm, be on call from 5pm to 7.30am and then continue with another normal shift until 5pm.
When the long hours, up to 34 or more at a stretch when a houseman is on call, were brought up in the past the Health Ministry blamed it on the shortage of doctors.
Health Ministry parliamentary secretary Datuk Lee Kah Choon said on call duties are part of a doctor’s responsibility, “but with the increase in the number of doctors joining the service, we hope the situation will get better in the future”.
But several medical officers who went through a “nightmarish” year as housemen said the long hours probably “did more harm than good”.
But a doctor, who did his housemanship in Malacca Hospital six years ago, disagreed saying he had to work seven days a week, including public holidays.
“If we wanted a day off, we had to apply for annual leave. It was terrible.
“I didn’t have a life outside the hospital. It got so bad, there was a time when out of sheer exhaustion I couldn’t perform CPR properly to resuscitate a patient.
“He was the third patient to collapse that night, and I was already spent from a lack of sleep and hard work.
“I think making doctors work so long probably does more harm than good,” he said.
He confirmed that housemen were treated badly by the medical officers, who referred to them as “the scum of the earth”.
Another doctor, who did her housemanship in Kuantan Hospital last year, said the hands-on experience was the best way to learn, but the working hours could be a little easier.
“We don’t mind working for 24 hours while on call and then doing the morning rounds. But at least they should let us off by midday so we can rest,” she said.
This was echoed by another doctor, based in Hospital Universiti Kebangsaan Malaysia, who said housemen were very often too tired to concentrate by the end of their long shifts.
“They can’t think properly, and this sometimes leads to wrong medical decisions as their judgment is affected.”

NST: KUALA LUMPUR: Tee Hui Yi, who was implanted with a mechanical heart two months ago, is progressing well.
A statement from the National Heart Institute (IJN) said the 13-year-old girl was transferred to the general ward on Nov 21 where she would undergo further rehabilitation. Prior to that, she was recuperating in the intensive care unit (ICU).
She would also be trained to self-manage her mechanical heart.
Tee, who is from Batu Pahat, is the country’s second mechanical heart assist recipient after Mohamed Fikri Nor Azmi, 16, received it last July.
Tee was taken off the ventilator on Nov 8 — a week after making her first post-surgery public appearance at a meeting with the media.
Throughout her stay in the ICU, she underwent daily cardio-pulmonary rehabilitation routine exercises. Two days after being taken off the ventilator, she started taking semi- solid food and on Nov 12, she started on a normal diet.
In celebration of her progress, the ICU staff treated her to her favourite food — fried chicken.
On Monday, she was taken to Lake Titiwangsa for morning exercises as part of the out-of-hospital programme.
Tee was diagnosed with end-stage heart failure when she was two years old after suffering from a viral infection. Since then, she became a regular patient at the Batu Pahat Hospital and the IJN.
Her condition deteriorated further and she was placed on the heart transplant list in May this year.
She has not been to school for two years.
On Sept 13, she was re-admitted to the IJN. While undergoing treatment, she developed a potential fatal heart rhythm.
It was a After this, that IJN decided to implant Tee with the mechanical heart.

Star: KUALA LUMPUR: Production of the herbal supplement Baike Wan has stopped and products bearing this name found on the shelves are dangerous imitations that should be avoided.
According to Shen Loon She Enterprise Sdn Bhd, the Penang-based registered licence holder of Baike Wan, the product was banned by the Health Ministry early last year .
Shen Loon She business development director Andy Lee said fake Baike Wan products contained harmful substances.
“There are three manufacturers in the country making the fake product that comes in different types of packaging, with the capsule shells imported from China.
“Our customers told us that they can buy the the imitation product for as low as RM28 from medical halls compared with the original price of RM43,” he said yesterday.
Lee said the original Baike Wan product contained herbal ingredients that could relieve muscle and joint pains. Because of the imitations, the company has renamed its product Edoly Capsules.
On whether fake Edoly Capsules could be produced, Lee said it would be difficult because all products registered with the Drug Control Authority were required to bear a hologram or Meditag.
Lee said his company had lodged reports with the police and the Health Ministry over the imitation products.
Health Ministry director-general Tan Sri Dr Mohd Ismail Merican said the ministry had received complaints from a foreign regulatory agency that Baike Wan from Malaysia contained scheduled poisons such as chlorpheniramine, piroxicam and frusemide.
“Chlorpheniramine is used to treat sinuses, piroxicam is a painkiller and frusemide can cause a drop in blood pressure,” he said in a press statement recently.
“These drugs are not allowed in traditional medicines as they can cause side effects if used without a doctor’s supervision.”
Dr Ismail reminded those with stock to stop sales immediately as it was an offence under the Control of Drugs and Cosmetics Regulations 1984, and carries a maximum fine of RM25,000, three years’ jail or both.

Star: PUTRAJAYA: Anyone caught with unregistered medicines and health supplement products in future may face tougher penalties under amendments to a key legislation.
Health Ministry’s pharmaceutical services division director Datuk Che Mohd Zin Che Awang said these products would include traditional medicine and over-the-counter items.
“This is because all traditional medicine and over-the-counter items must now be registered by the Drug Control Authority. Any product, even traditional medicine, which is unregistered, is illegal.
“Previously, we had to prove that anyone caught with the illegal products had the intention to sell them before we could charge the individual with a more serious offence under the Control of Drugs and Cosmetics Regulations 1984,” he said.
“But now, under the proposed amendments, we can charge them with possession – regardless of whether the items are for sale or not, and it will carry a heavier penalty.”
Anyone convicted can face a fine of up to RM35,000 for the first offence and RM50,000 for the subsequent offence or a five-year jail term.
For companies, the fine can go up to between RM50,000 and RM100,000.
The introduction of Meditag holograms for all registered medicines and health supplement products last year had made it easier for enforcement officers to identify and confiscate illegal products, he said.
For the first 10 months of this year, 22,000 items without the Meditag holograms were seized.
“We should see a drop in these illegal products by the end of the year, he said.
The ministry is drafting amendments to the Poisons Act to provide stiffer punishment for clinics that illegally “divert” certain types of psychotropic drugs such as buprenorphine (used for drug substitution therapy), midazolam (used to treat insomnia) and pseudoepherine tablets (precursors contained in cold remedies)
At present, the penalty is a RM5,000 fine.
The Poisons Act covers both products and raw materials containing scheduled or controlled substances.
Che Mohd Zin said if a substance was an unregistered item, clinic owners found selling it could be jailed up to three years or fined up to RM25,000 or both for the first offence under the Control of Drugs and Cosmetics Regulations 1984.

KUALA LUMPUR, Nov 29 (Bernama) — Botox, the anti-ageing agent banned by the National Fatwa Council, is safe for consumer use if administered by specialists.
Deputy Health Minister Datuk Dr Abd. Latif Ahmad said consumers however should be wary of the side effects of the botox injections.
“However, the botox injections are not available at any hospital or clinic under the Ministry of Health,” he said when winding up the debate on the Supply Bill 2007 in the Dewan Rakyat here.
Botox or Botulinum Toxin Type A is used to reduce facial wrinkles.
Abd Latif disclosed that the Medical Devices Act and the Cosmetics Act were at the final stages of drafting before being presented to the Attorney-General and the Cabinet for approval.
He also said that the rise in breast cancer cases could be due to the lifestyle of modern women who chose not to breastfeed their babies.
In this respect, the government had allocated RM500 million under the Ninth Malaysia Plan (9MP) to build a cancer institute next to the Putrajaya Hospital for cancer research, he added.
On the use of silicon for cosmetic purposes, he said the Food and Drugs Administration (FDA) of the United States had determined that silicon implants were safe if handled by specialists.
“Government hospitals have conducted 50 plastic surgeries for reconstructive purposes but no cosmetic surgery has ever been done,” he said.
The Deputy Minister said it was difficult to trace cases of cosmetic surgeries involving silicon implants as there had been no reports from consumers.
“Normally, those who have gone for silicon implants are shy to come forward especially when they have been scarred physically,” he said.
Abd Latif said that other than the Kuala Lumpur Hospital (HKL), there were seven other hospitals in the Klang Valley serving about three million people.
They are the Ampang Hospital, Sungai Buloh Hospital, Serdang Hospital, Selayang Hospital, Tengku Ampuan Rahimah Hospital, Kajang Hospital and Putrajaya Hospital.
He dismissed claims that the ministry had discriminated other races when recruiting nurses for government hospitals as it was done by the Public Service Commission (PSC).

KUALA LUMPUR, Nov 29 (Bernama) — Chinese physicians who meet the Health Ministry’s requirements can serve in three government hospitals following the government’s decision to recognise traditional medication including acupuncture starting next year.
Former Professional Acupuncture Academy president and Tiong Hua Medical Practitioners Association Malaysia president Yong Kian Fui said Wednesday the ministry had sought his assistance to prepare a list of names of qualified physicians.
“The government plans to set up a division of Chinese, Malay and Indian traditional medical practitioners at the Putrajaya Hospital, Kepala Batas Hospital and Sultan Ismail Hospital in Johor next year,” he told Bernama.
Health Minister Datuk Seri Dr Chua Soi Lek, during a visit to China two weeks ago, said that the ministry planned to use traditional medicine to complement healthcare in the three hospitals.
Meanwhile, secretary of the Federation of Chinese Physicians and Acupuncture Association of Malaysia Ng Po Kok said several guidelines had been drawn up for the service.
“They must have a pass in Bahasa Melayu at SPM level and certificate in the relevant field,” he said.
On salaries, he said a meeting would be held on the matter.
There are about 10,000 traditional medical practitioners in the country.

November 29, 2006

Star: PUTRAJAYA: Tougher penalties are in store for clinics that illegally sell certain types of psychotropic drugs.
The Health Ministry is currently drafting amendments to the Poisons Act to provide stiffer punishment.
“The draft is in the final stage,” said the ministry’s pharmaceutical services division director Datuk Che Mohd Zin Che Awang.
At present, the penalty is a RM5,000 fine.
Psychotropic substances affect mental activity and behaviour and are used in drug substitution therapy (DST), a treatment many private clinics provide.
The Act covers substances that are not required to be registered under the Drug Control Authority.
Che Mohd Zin said if a substance was a registered item, clinic owners found selling it could be jailed up to three years or fined up to RM25,000 or both for the first offence, under the Control of Drugs and Cosmetics Regulations.
“For a subsequent offence, the penalty is a RM50,000 fine or five years’ jail, or both,” he said.
“If the item is not one that requires registration, the clinics can be charged under the Poisons Act.”
Che Mohd Zin said, last year, the ministry inspected 87 private medical clinics that supplied psychotropic tablets.
At least 31 clinics had not followed treatment protocol in supplying the tablets, he said.
Che Mohd Zin added that his department closely monitored and analysed any trend of abuse, especially of buprenorphine and midazolam (used to treat insomnia) and pseudoepherine tablets (precursors contained in cold remedies).
Three pharmacies and two private clinics were investigated for a high volume purchase of pseudoepherine tablets, he told The Star, when commenting on the findings in the department’s annual report for last year.
The annual report stated that 74 products were recalled from the market last year. Three, which were traditional medicine, were issued orders for product recalls within 24 hours.
Seventy-one other products, comprising 12 prescription drugs, three non-prescription drugs and 56 traditional medicines, were to be recalled within 30 days, the report said.

November 28, 2006

NST: PUTRAJAYA: Pre-schools and kindergartens in Sarawak which failed to maintain cleanliness will not be allowed to resume operations when school reopens next year.
Operators have to abide by the guidelines issued by the Health Ministry to prevent an outbreak of the hand, foot and mouth disease. Sarawak has been the hardest hit by HFMD.
This year, it recorded 14,410 cases after an epidemic broke out in January.
Deputy Prime Minister Datuk Seri Najib Razak warned operators to toe the line, adding that checks on kindergartens in the state would be carried out before the start of the new academic session.
He said the tough measures were necessary as the number of cases continued to rise.
“There will be enforcement to ensure that pre-schools and kindergartens follow the guidelines. This covers all private and public facilities, including those run by the ministries of Rural and Regional Development, Education, and Women, Family and Community Development,” Najib said after chairing a meeting of the Cabinet Committee on Health and Cleanliness yesterday.
The guidelines cover the cleanliness of bathrooms, kitchens, toys, play areas and the handling of children affected by the disease.
Children are the most susceptible to HFMD, which spreads through the mucus and faeces of infected persons.
The symptoms are a fever, a rash, ulcers in the mouth and sores or blisters on the palms and feet.
The committee also discussed the sudden spike in the number of dengue cases, from the average of 400 a week to 800 last week.
Najib said Kuala Lumpur and Selangor had been identified as the most critical areas due to idle construction projects, rubbish problems and clogged drains.
In view of Visit Malaysia Year next year, the Cabinet wanted more effort into sprucing up the Klang Valley and keeping it disease-free. One measure will involve the free distribution of Abate larvicide through public clinics and healthcare facilities.

Star: KUCHING: Compounds from certain plants in Sarawak have been found to contain anti-HIV agents and properties that could be used to treat leukaemia, said state Second Minister for Planning and Resource Management Datuk Awang Tengah Ali Hasan.
He said the Sarawak Biodiversity Centre was also screening plant extracts for anti-cancer compounds.
“The centre is working with the Cancer Research Initiative Foundation to screen plant compounds that might be used in photodynamic therapy for cancer,” he said in reply to points raised by members during the debate on the 2007 state budget at the Sarawak State Assembly here yesterday. Awang Tengah said the centre had documented 1,985 plant samples used by the various indigenous communities for medicinal purposes and food. Of the collection, 180 species have been identified.
“It has been undertaking various research projects with domestic and foreign institutions and parties to develop our biological resources for pharmaceutical and nutraceutical use,” he said.